Angina is chest pain or discomfort that occurs when your heart muscle
does not get enough blood. Angina may feel like pressure or a squeezing
pain in your chest. The pain may also occur in your shoulders, arms,
neck, jaw, or back. It may also feel like indigestion.

Angina is a symptom of
coronary artery disease (CAD), the most common type of heart
disease. CAD occurs when plaque builds up in the coronary arteries. This
buildup of plaque is called
atherosclerosis. As plaque builds up, the coronary arteries become
narrow and stiff. Blood flow to the heart is reduced. This decreases the
oxygen supply to the heart muscle.

Types of Angina

There are 3 types of angina-stable, unstable, and variant
(Prinzmetal's). It is very important to know the differences among the
types.

Stable angina. Stable angina is the
most common type. It occurs when the heart is working harder than usual.

There is a regular pattern to stable angina.

After several episodes, you learn to recognize the pattern and can
predict when it will occur.

The pain usually goes away in a few minutes when you rest or take
your angina medicine.

Stable angina is not a heart attack but makes it more likely that
you will have a heart attack in the future.

Unstable angina. Unstable angina is a
very dangerous condition that requires emergency treatment. It is a sign
that a heart attack could occur soon. Unlike stable angina, it does not
follow a pattern. It can occur without physical exertion and is not
relieved by rest or medicine.

Variant angina. Variant angina is rare.
It usually occurs at rest. The pain can be severe and usually occurs
between midnight and early morning. It is relieved by medication.

Not all chest pain or discomfort is angina.
Chest pain or discomfort can be caused by a heart attack, lung problems
(such as an infection or a blood clot), heartburn, or a panic attack.
However, all chest pain should be checked
by a doctor.

What Causes Angina?

Angina is caused by reduced blood flow to an area of the heart. This is
most often due to
coronary artery disease (CAD). Sometimes, other types of heart
disease or uncontrolled high blood pressure can cause angina.

In CAD, the arteries that carry oxygen-rich blood to the heart muscle
are narrowed due to the buildup of fatty deposits called plaque. This is
called
atherosclerosis. Some plaque is hard and stable and leads to
narrowed and hardened arteries. Other plaque is soft and is more likely
to break open and cause blood clots. The buildup of plaque on the inner
walls of the arteries can cause angina in two ways:

By narrowing the artery to the point where the flow of blood is
greatly reduced

By forming blood clots that partially or totally block the artery.

Stable Angina

Physical exertion is the most common cause of pain and discomfort from
stable angina. Severely narrowed arteries may allow enough blood to
reach the heart when the demand for oxygen is low (such as when you are
sitting). But with exertion like walking up a hill or climbing stairs,
the heart works harder and needs more oxygen. Other causes include:

Emotional stress

Exposure to very hot or cold temperature

Heavy meals

Smoking.

Unstable Angina

Unstable angina is caused by blood clots that partially or totally block
an artery. If plaque in an artery ruptures or breaks open, blood clots
may form. This creates a larger blockage. The clot may grow large enough
to completely block the artery and cause a heart attack. Blood clots may
form, partly dissolve, and later form again. Chest pain can occur each
time a clot blocks an artery.

Variant Angina

Variant angina is caused by a
spasm in a coronary artery. The spasm causes the walls of the artery
to tighten. This narrows the artery, causing the blood flow to the heart
to slow or stop. Variant angina may occur in persons with and without
CAD. Other causes of spasms in the arteries that supply the heart with
blood are:

Is often described as pressure, squeezing, burning, or
tightness in the chest

Usually starts in the chest behind the breastbone

May also occur in the arms, shoulders, neck, jaw, throat,
or back

May feel like indigestion.

Some people say that angina discomfort is hard to describe or
that they can't tell exactly where the pain is coming from.
Symptoms such as nausea, fatigue, shortness of breath, sweating,
light-headedness, or weakness may also occur.

Symptoms vary based on the type of angina.

Stable Angina

The pain or discomfort:

Occurs when the heart must work harder, usually during
physical exertion

Is expected, and episodes of pain tend to be alike

Usually lasts a short time (5 minutes or less)

Is relieved by rest or angina medicine

May feel like gas or indigestion

May feel like chest pain that spreads to the arms, back,
or other areas.

Unstable Angina

The pain or discomfort:

Often occurs at rest, while sleeping at night, or with
little physical exertion

Is unexpected

Is more severe and lasts longer (as long as 30 minutes)
than stable angina episodes

Is usually not relieved with rest or angina medicine

May get continuously worse

May signal that a heart attack will happen soon.

Variant Angina

The pain or discomfort:

Usually occurs at rest and during the night or early
morning hours

Tends to be severe

Is relieved by angina medicine.

Chest pain that lasts longer
than a few minutes and is not relieved by rest or angina
medicine may mean you are having-or are about to have-a heart
attack. Get emergency help right away.

How is Angina
Treated?

Treatment for angina includes lifestyle changes,
medication, surgery, and rehabilitation. The main goals
of treatment are to:

Reduce the frequency and severity of symptoms

Prevent or lower the risk of heart attack and
death.

Lifestyle changes and medication may be the only
treatments needed if your symptoms are mild and are not
getting worse. Unstable angina is an emergency condition
that requires treatment in the hospital.

Lifestyle Changes

The first thing that you need to do is change your
living habits to avoid bringing on an episode of angina.
If angina comes on

With exertion, slow down or take rest breaks.

After a heavy meal, avoid large meals and rich
foods that leave you feeling stuffed.

With stress, try to avoid situations that make you
upset or stressed. Learn techniques to handle stress
that can't be avoided.

If you have
diabetes, follow your doctor's orders and take all
medications as directed.

Medications

Nitrates are the most commonly used medicines to
treat angina. Fast-acting preparations are taken when
angina occurs or is expected to occur. Nitrates relax
and widen blood vessels, allowing more blood to flow to
the heart while reducing its workload.

You can use nitrates in different forms to:

Relieve an episode that is occurring by using the
medicine when the pain begins

Prevent episodes from occurring by using the
medicine just before pain or discomfort is expected to
occur

Reduce the number of episodes that occur by using
the medicine regularly on a long-term basis.

Oral antiplatelet (an-ty-PLAYT-lit) medicines
(such as aspirin and
clopidigrel) taken daily to stop platelets from
clumping together to form blood clots. Platelets are
small blood cell fragments that circulate through your
blood vessels and help stop bleeding by sticking
together to seal small cuts or breaks in tiny blood
vessels. Antiplatelet medicines may not be appropriate
for some people because they increase the risk of
bleeding. Discuss the benefits and risks with your
doctor before starting therapy with aspirin or the
other antiplatelet medicines.

Glycoprotein IIb-IIIa inhibitors are potent
antiplatelet medicines that prevent clots from forming
in your arteries. They are given intravenously in
hospitalized patients in the treatment of angina or
during and after angioplasty.

When medicines and other treatments do not control
angina, special procedures may be needed. Two commonly
used procedures are:

Angioplasty
to open blocked or narrowed coronary arteries. It can
improve blood flow to your heart, relieve chest pain,
and possibly prevent a heart attack. Sometimes a stent
is placed in the artery to keep it propped open after
the procedure.

Your doctor may prescribe cardiac rehab for angina or
after bypass surgery, angioplasty, or a heart attack.

The cardiac rehab team may include:

Doctors

Your family doctor

A heart specialist

A surgeon

Nurses

Exercise specialists

Physical therapists and occupational therapists

Dietitians

Psychologists or other behavior therapists.

Rehab has two parts:

Exercise training
to help you learn how to exercise safely, strengthen
your muscles, and improve your stamina. Your exercise
plan will be based on your individual ability, needs,
and interests.

Education,
counseling, and training to help you understand
your heart condition and find ways to reduce your risk
of future heart problems. The cardiac rehab team will
help you learn how to cope with the stress of
adjusting to a new lifestyle and to deal with your
fears about the future.

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